Materiały źródłowe

• #1 Diagnosis and management of asthma in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9045042/

  Asthma is the the most common chronic respiratory condition of childhood worldwide, with around 14% of children and young people affected. […] There are several diagnostic challenges, and as a result, both overdiagnosis and underdiagnosis of paediatric asthma remain problematic. […] Diagnosing asthma in childhood can be challenging, and the diagnosis should be reviewed during follow-up to ensure it is correct. […] There is no single gold-standard test that can be used to accurately diagnose asthma. In practice, a diagnosis should be made based on characteristic symptom patterns, evidence of variability in airflow limitation in the presence of airway inflammation, likelihood of alternative diagnoses and response to treatment. […] Lung function tests can be used to aid the diagnosis of asthma in children over the age of 5 years.

• #2 Diagnosis and management of asthma in children | BMJ Paediatrics Open

  https://bmjpaedsopen.bmj.com/content/6/1/e001277

  Asthma is the most common chronic respiratory condition of childhood worldwide, with around 14% of children and young people affected. […] There are several diagnostic challenges, and as a result, both overdiagnosis and underdiagnosis of paediatric asthma remain problematic. […] Diagnosing asthma in childhood can be challenging, and the diagnosis should be reviewed during follow-up to ensure it is correct. […] There is no single gold-standard test that can be used to accurately diagnose asthma. In practice, a diagnosis should be made based on characteristic symptom patterns, evidence of variability in airflow limitation in the presence of airway inflammation, likelihood of alternative diagnoses and response to treatment. […] Lung function tests can be used to aid the diagnosis of asthma in children over the age of 5 years.

• #3

  https://www.healthychildren.org/English/health-issues/conditions/allergies-asthma/Pages/Diagnosing-Asthma.aspx

  Asthma is the most common chronic respiratory disease in children. It affects more than 6 million U.S. children and leads to over 13 million missed days of school each year. Yet as common as it is, asthma can be challenging to diagnose in children. There is no one-size-fits-all set of symptoms. A solid, ongoing relationship with your child’s health provider can help identify asthma risks and the best treatment for your child. […] Pediatricians have many tools to help identify and support a child who might have asthma. The most important tool of all is the child’s medical history. Depending on their age, some children will not have wheezing during an asthma flare, but rather a chronic cough that lasts for days or appears during illness or activity. […] If a child is old enough, usually over age 7 years, your health care provider may request an asthma test. One of the most common ones uses spirometry to check lung function. For this test, the child breathes into a device that will show whether your child has some airway blockage.

• #4

  https://bpac.org.nz/bpj/2012/february/asthma.aspx

  New Zealand has one of the highest rates of childhood asthma in the developed world. It is the leading cause of sleep disturbance, missed school days and hospital admissions in children. […] The following article outlines the diagnosis and management of asthma in children aged one to 15 years, and is based on the British Thoracic Society/Scottish Intercollegiate Network guideline, adapted to reflect New Zealand practice. […] The diagnosis of asthma in children is clinical and based on history, examination and assessing the response to treatment. While investigations such as respiratory function testing may be helpful in pointing to a diagnosis, there is no single diagnostic test for asthma in children. The likelihood of a child having asthma is determined by how well the symptoms fit the typical pattern of recurrent episodic symptoms, including wheeze, and whether features to suggest an alternative diagnosis are present.

• #5 Asthma in Children: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/6776-asthma-in-children

  Asthma is a lung disease that causes your airways to swell and narrow, making it very hard to breathe. […] Asthma can begin at any age, but it most often starts during childhood when your child’s immune system is still developing. Most children who get asthma have their first symptom by age 5. […] Asthma is the leading cause of chronic illness in children. It affects about 7.5 million children in the United States. […] Asthma is often difficult to diagnose in children, especially when they’re younger than age 6. The condition can have similar symptoms to other illnesses. […] Your child’s pediatrician may diagnose the disease based on your child’s medical history, symptoms and a physical examination. […] If possible, your child’s provider may request a few tests to diagnose asthma.

• #6 Testing for your child’s asthma | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/asthma/child/diagnosis/tests

  Lung tests and symptoms can confirm an asthma diagnosis. If your child is over five, their GP may ask them to do these tests. […] There’s no single test to diagnose asthma, so your child’s GP might do a few different tests. Tests on their own are not enough to confirm a diagnosis. Your child’s symptoms, how often they get them, and their family history are also an important part of the diagnosis. […] Diagnosing asthma in children under five can be hard. This is because some children find it hard to do the tests well enough to get useful results. So, a diagnosis is usually based on how well they respond to their medicine. […] If your child’s GP thinks they might have asthma, they may give your child a very low dose of preventer medicine to see if their symptoms get better. […] When your child is five, they can try the asthma tests to see how their lungs are working.

• #7 Diagnosis and management of asthma in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9045042/

  Guidelines vary between countries and regions with regard to diagnostic criteria. […] Objective testing should be repeated if there is poor response to treatment or diagnostic uncertainty. […] The diagnosis of asthma should therefore be reviewed routinely to identify true asthma and alter treatment where necessary. […] The management of asthma is multifactorial, and to optimise disease control, a number of pharmacological, non-pharmacological and self-management aspects need to be considered. […] Most paediatric asthma cases are diagnosed in primary care without the input of general paediatricians or paediatric respiratory physicians. […] A key element of specialist care is a multidisciplinary team consisting of a number of professionals, including specialist nurses, psychologists, physiologists and pharmacists. […] Asthma attacks should be viewed as never events. It is essential that a postattack review is conducted to review asthma maintenance treatment, as this is likely to be suboptimal. […] In order to improve outcomes, accurate diagnosis and management are essential.

• #8 Asthma Diagnosis | AAFA.org

  https://aafa.org/asthma/asthma-diagnosis/

  To diagnose asthma, your doctor will talk to you about your personal and medical history. They may ask if you have a family history of allergies and asthma and will perform a physical exam. […] For example, if you have a history of allergies or eczema, you have a higher chance of having asthma. Also, a family history of asthma, allergies, or eczema increases your chance of having asthma. This information can help your doctor make a diagnosis of asthma. […] The doctor may also ask if you get chest symptoms when you: […] Your doctor will do a physical exam to look for signs of asthma or other related conditions. […] To confirm asthma, your doctor may have you take one or more breathing tests known as lung function tests (also called pulmonary function tests). […] If your lung function improves a lot with use of a bronchodilator, you could have asthma. Your doctor may prescribe a trial with asthma medicine to see if it helps.

• #9 Asthma: Steps in testing and diagnosis

  https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma/art-20045198

  Diagnosing asthma generally includes a medical history, physical exam and lung tests. […] An asthma diagnosis is based on several factors, including a detailed medical history, a physical exam, your symptoms, and overall health and test results. […] The first step in diagnosing asthma is talking to your healthcare team about your symptoms and your health. […] Your healthcare professional may use several tests to check how well your lungs are working. […] This is the main test doctors generally use to diagnose asthma in people 5 years or older. […] If your spirometer results are typical or near typical, your healthcare professional might try to trigger asthma symptoms. […] Lung tests in children under age 5 are not typically done. Instead, diagnosis is generally based on a child’s symptoms, medical history and physical examination.

• #10 Childhood Asthma: Symptoms, Diagnosis, and Treatment

  https://www.webmd.com/asthma/children-asthma

  Your childs asthma symptoms may be gone by the time you get to the doctors office. You have an important role in helping your doctor understand whats going on. A diagnosis will include: […] Questions about medical history and symptoms. Your doctor will ask about any breathing problems your child may have had, as well as any family history of asthma, allergies, eczema, or other lung disease. Describe your child’s symptoms in detail, including when and how often they happen. […] Physical exam. Your doctor will listen to your child’s heart and lungs and look in their nose or eyes for signs of allergies. […] Tests. Your child might get a chest X-ray. If theyre 6 or older, they may have a simple lung test called spirometry. It measures the amount of air in your childs lungs and how fast they can blow it out. This helps the doctor find out how severe their asthma is. Other tests can help find asthma triggers. They may include allergy skin testing, blood tests such as immunoglobulin E (IgE) test or radioallergosorbent test (RAST), and X-rays. These tests can help your doctor check if sinus infections or gastroesophageal reflux disease (GERD) are making asthma worse. A test that measures the level of nitric oxide (eNO) in your childs breath can also point to inflamed airways.

• #11 Asthma: Updated Diagnosis and Management Recommendations from GINA | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0615/p762.html

  The diagnosis of asthma continues to require characteristic symptoms and evidence of variable airflow limitation on pulmonary function testing. The characteristic symptoms, especially in adults, include wheezing, shortness of breath, cough, and chest tightness that are worse at night or early in the morning; vary over time and in intensity; and are triggered by viral infections (colds), exercise, allergen exposure, changes in weather, laughter, or irritants. […] An asthma diagnosis should be confirmed with pulmonary function testing to avoid overtreatment and to ensure that other diagnoses are not missed. In one study, 2% of adults diagnosed with asthma had serious cardiorespiratory conditions that were missed. […] In asthma, lung function can vary between normal and severely obstructed, especially when poorly controlled. In adults with characteristic symptoms, an increase or decrease in forced expiratory volume in one second (FEV1) of greater than 12% and 200 mL from baseline or a change in peak expiratory flow of at least 20% is consistent with asthma.

• #12 Patient education: Asthma symptoms and diagnosis in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/asthma-symptoms-and-diagnosis-in-children-beyond-the-basics

  Patient education: Asthma symptoms and diagnosis in children (Beyond the Basics) […] This topic review discusses the risk factors, symptoms, and diagnosis of asthma in children. […] The diagnosis of asthma in children requires a careful review of a child’s current and past medical history, family history, and a physical examination. Specialized testing is sometimes needed to diagnose asthma and to rule out other possible causes of symptoms. […] Spirometry testing — Spirometry measures the flow and volume of air blown out after a child takes a very deep breath and then forcefully exhales. If airflow obstruction is present, the test may be repeated after the child uses an asthma inhaler or nebulizer (bronchodilator) to confirm that the obstruction is reversible (a feature of asthma). […] Challenge testing — A bronchial challenge test may be recommended to diagnose asthma. This testing is designed to cause the airways to narrow in children with asthma.

• #13 Pediatric Asthma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551631/

  Pediatric asthma is characterized by variable expiratory airway limitation and persistent respiratory symptoms, including wheezing, coughing, shortness of breath, and chest tightness. […] Assessment evaluates symptom intensity, exacerbation risk, and the likelihood of persistent asthma, guiding treatment decisions accordingly. […] The cornerstone of diagnostic evaluation is spirometry, which aids in identifying chest wall, respiratory muscle defects, and respiratory muscle weakness. […] Evaluation with spirometry, complemented by postbronchodilator response, is pivotal for establishing a definitive diagnosis. […] Spirometry is recommended by the National Asthma Education and Prevention Program (NAEPP) for patients aged 5 and older. […] Diagnosing asthma for children aged 5 or younger can be challenging.

• #14 Diagnosing Asthma in Children | NYU Langone Health

  https://nyulangone.org/conditions/asthma-in-children/diagnosis

  In a bronchodilator challenge test, performed in the doctors office after spirometry, your child inhales a bronchodilator medication called albuterol, which opens up the airways, and exhales into the spirometer again. […] The test measures whether using the medication increases air volume and flow. […] Impulse oscillometry can help doctors diagnose asthma in younger children who have difficulty forcing air into a spirometer. […] Your doctor may suggest an allergy test to look for evidence of an allergy as an underlying cause of your childs asthma symptoms. […] Information from these tests helps our doctors make an asthma diagnosis and determine the severity of your childs condition.

• #15 Asthma Test for Kids | Norton Children’s Louisville, Ky.

  https://nortonchildrens.com/services/pediatric-pulmonologist/services/asthma/tests/

  Impulse oscillometry (IOS): This simple asthma test requires only normal breathing through a mouthpiece or mask. Due to its simplicity, this test can be used in children as young as age 3. It is not as widely available as spirometry. Norton Children’s is a national leader in the use of IOS. […] Exhaled nitric oxide test: This simple, noninvasive test measures an important type of airway inflammation. […] Additional tests may be ordered to rule out other causes of your child’s symptoms or identify conditions affecting them in addition to asthma. These can include an assessment for gastroesophageal reflux disease (GERD), as well as allergy skin tests and blood tests that can identify allergens that are causing your child’s symptoms or making their asthma worse. […] Understanding your child’s symptoms and how to treat them can save their life. Addressing the causes of your child’s asthma attacks is the first step in controlling their condition.

• #16 Pediatric Asthma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551631/

  The presence of intermittent or chronic symptoms consistent with asthma, along with wheezing on physical examination, strongly suggests the diagnosis of asthma. […] Confirming the diagnosis involves excluding alternative diagnoses and demonstrating variable airflow limitation, typically observed on spirometry. […] Selective allergy testing can help develop avoidance strategies for children exposed to furry animals, molds, cockroaches, or dust mites. […] During bronchoprovocation testing, clinicians induce bronchoconstriction using inhaled methacholine, cold air, or exercise. […] Eosinophilic airway inflammation causes an upregulation of nitric oxide synthase in the respiratory mucosa and increased nitric oxide levels in the exhaled breath. […] The initial treatment of pediatric asthma is determined by assessing the intensity and severity of symptoms and the likelihood of future exacerbations.

• #17 Pediatric Asthma Workup: Approach Considerations, Pulmonary Function Tests, Exercise Challenge

  https://emedicine.medscape.com/article/1000997-workup

  According to the National Asthma Education and Prevention Program guidelines, spirometry is an essential objective measure for establishing the diagnosis of asthma. Additional studies are not routinely necessary, but they may be useful when the clinician is considering alternative diagnoses. […] Eosinophil counts and IgE levels may be useful when allergic factors are suspected. […] Bronchial provocation tests may be performed to diagnose bronchial hyperresponsiveness (BHR). […] The degree of airway responsiveness can be assessed by methacholine challenge testing. […] Methacholine challenge testing is more useful in excluding a diagnosis of asthma than in establishing one because its negative predictive power is greater than its positive predictive power. […] Measuring the fraction of exhaled nitric oxide (FeNO) has proved useful as a noninvasive marker of airway inflammation, in order to guide adjustment of the dose of inhaled corticosteroids.

• #17 Pediatric Asthma Workup: Approach Considerations, Pulmonary Function Tests, Exercise Challenge

  https://emedicine.medscape.com/article/1000997-workup

  Include chest radiography in the initial workup if the asthma does not respond to therapy as expected. […] Allergy testing can be used to identify allergic factors that may significantly contribute to the asthma. […] Asthma is an inflammatory disease characterized by the recruitment of inflammatory cells, vascular congestion, increased vascular permeability, increased tissue volume, and the presence of an exudate.

• #18

  https://www.healthychildren.org/English/health-issues/conditions/allergies-asthma/Pages/Diagnosing-Asthma.aspx

  Another test developed over the past decade checks how much nitric oxide your child exhales. This measures how much inflammation there is in the airway. Pediatric specialty centers may also offer more complex lung function testing, imaging tests and techniques such as methacholine provocative challenges, which gauges how „reactive” a child’s lungs are. These tests may be used for the diagnosis and follow-up management of asthma. […] There are many tools that can help diagnose asthma, and treatment and medications that can help a child with asthma thrive. If you think your child may have asthma, talk with your pediatrician.

• #19 Recommendations | Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) | Guidance | NICE

  https://www.nice.org.uk/guidance/ng245/chapter/recommendations

  1.2 Objective tests for diagnosing asthma in adults, young people and children aged 5 to 16 with a history suggestive of asthma […] 1.3 Diagnosing asthma in children under 5 […] 1.2.5 Measure the FeNO level in children with a history suggestive of asthma. Diagnose asthma if the FeNO level is 35 ppb or more. […] 1.3.1 For children under 5 with suspected asthma, treat with inhaled corticosteroids in line with the recommendations on medicines for initial management in children under 5, and review the child on a regular basis. […] 1.3.3 Refer to a specialist respiratory paediatrician any preschool child with an admission to hospital, or 2 or more admissions to an emergency department, with wheeze in a 12-month period. […] 1.4.1 In people with adult-onset asthma, poorly controlled established asthma, or reappearance of childhood asthma, check for a possible occupational component by asking:

• #19 Recommendations | Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) | Guidance | NICE

  https://www.nice.org.uk/guidance/ng245/chapter/recommendations

  1.5.1 Monitor asthma control at every review. In addition to asking about symptoms, check: […] 1.5.2 Consider using a validated symptom questionnaire (for example, the Asthma Control Questionnaire, the Asthma Control Test or the Childhood Asthma Control Test) at any asthma review. […] 1.3.2 If a child is unable to perform objective tests when they are aged 5: […] 1.9.1 Consider an 8 to 12 week trial of twice-daily paediatric low-dose inhaled corticosteroid (ICS) as maintenance therapy (with a short-acting beta2 agonist [SABA] for reliever therapy) in children under 5 with suspected asthma and: […] 1.9.5 If suspected asthma is uncontrolled in children under 5 on a paediatric moderate dose of ICS as maintenance therapy (with SABA as needed), consider a leukotriene receptor antagonist (LTRA) in addition to the ICS. […] 1.9.6 If suspected asthma is uncontrolled in children under 5 on a paediatric moderate dose of ICS as maintenance therapy and a trial of an LTRA has been unsuccessful or not tolerated, stop the LTRA and refer the child to a specialist in asthma care for further investigation and management.

• #20 Asthma Diagnosis | AAFA.org

  https://aafa.org/asthma/asthma-diagnosis/

  Most people with asthma have allergies that trigger or worsen their asthma. […] Your doctor may order blood tests to check your immune system. […] If your doctor thinks you have something other than asthma or related to asthma, they may run other tests. […] There are 4 levels of asthma, based on the severity of your asthma. […] The answers to these questions help to determine the severity of your asthma. […] Diagnosing asthma in children under age 5 is a little different. It involves a careful process of history taking, physical exam, and diagnostic studies. […] If the bronchodilator helps reduce your child’s symptoms, that is a sign that your child may have asthma.

• #21 Testing for your child’s asthma | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/asthma/child/diagnosis/tests

  If the diagnosis is still not clear after these tests, your child’s GP might ask your child to do them again in around 8 weeks. […] A positive test means that asthma is more likely, but a negative test won’t rule out an asthma diagnosis. Your child’s GP might refer them for a spirometry test if they need more information to confirm the diagnosis. […] Spirometry tests measure how much air your child can blow out in one forced breath. […] If your child’s airways are blocked and narrow, the GP might want to see how they respond to reliever medicine. […] Your child’s GP might suggest a skin prick or blood test if the results from FeNO, spirometry or peak flow tests are not clear. But, they still suspect your child might have asthma. […] If your child has a positive skin prick test, they can be diagnosed with asthma. […] If your child has higher than normal levels in their blood, they can be diagnosed with asthma.

• #22 Asthma Diagnosis and Testing – Allergy & Asthma Network

  https://allergyasthmanetwork.org/what-is-asthma/how-is-asthma-diagnosed/

  Diagnosing asthma is often difficult. For many, asthma symptoms tend to come and go. […] How is asthma diagnosed in children? […] In children under the age of 5, most asthma lung function tests are not reliable. So asthma in young children is primarily diagnosed based on symptoms, family and health history, and a physical exam. […] If allergies (pollen, mold or pet dander) are a suspected asthma trigger, then your doctor may consider allergy testing (such as skin tests). […] For most children under 5, confirmation of a diagnosis of asthma may have to wait until they’re older and can undergo diagnostic testing. […] In older children and teens, asthma is diagnosed the same way it is in adults.

• #23 Asthma: Steps in testing and diagnosis

  https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma/art-20045198

  If your child’s healthcare professional suspects asthma, your child may be prescribed a bronchodilator a drug that opens the airways. […] You breathe into a tube connected to a machine that measures the amount of nitric oxide gas in your breath. […] Your healthcare professional also may perform allergy tests. […] Even if a diagnosis isn’t certain, your care professional may prescribe medicines or other treatment to see what helps.

• #24 Asthma in Children – Asthma Canada

  https://asthma.ca/get-help/asthma-in-children/

  Reversibility of airway obstruction is a key feature of asthma. […] If administering a bronchodilator reverses airway narrowing significantly, the diagnosis is probably asthma. […] The diagnosis is based on the baby’s allergy and health history, physical exam and the parents history of allergy and asthma. […] A child with recurring bouts of coughing and wheezing with lingering symptoms is likely to have Asthma. […] Again, if the child responds well to a trial of asthma medications, this is also indicative of asthma.

• #25 Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediat | Canadian Paediatric Society

  https://cps.ca/documents/position/asthma-in-preschoolers

  Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. […] In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (8 days/month) asthma-like symptoms or recurrent (2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. […] The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy.

• #26 Diagnosing childhood asthma – European Lung Foundation

  https://europeanlung.org/en/information-hub/guidelines/diagnosing-childhood-asthma-understanding-the-professional-guidelines/

  The guidelines recommend that spirometry tests are used to confirm whether asthma is present alongside the two tests described below. […] If the spirometry test suggests a child has asthma, BDR testing should be the next step to confirm the diagnosis. […] FeNO testing involves breathing into a machine that measures the amount of nitric oxide that is breathed out. […] The guidelines recommend the three tests above as the best tests to diagnose asthma. […] The guidelines do not recommend using a trial of asthma medicine to confirm or rule out asthma as there is not enough evidence to suggest it can give an accurate diagnosis. […] The guidelines suggest that this is not as accurate as spirometry, BDR and FeNO testing outlined above. […] The guidelines therefore recommend that it is only offered if it has not been possible to diagnose asthma from the three key tests listed above and a child’s symptoms have not gone away.

• #27 Diagnosing childhood asthma – European Lung Foundation

  https://europeanlung.org/en/information-hub/guidelines/diagnosing-childhood-asthma-understanding-the-professional-guidelines/

  The guidelines recommend that these tests are not used to diagnose asthma. The evidence suggests that they are not accurate enough. […] The European Respiratory Society Guidelines recommend using two results from three key tests (spirometry, BDR testing and FeNO testing) to confirm or rule out whether a child has asthma.

• #28 Diagnosing Childhood Asthma | Doctor

  https://patient.info/doctor/diagnosing-childhood-asthma-in-primary-care

  NICE recommends performing objective tests from the outset if asthma is suspected on clinical grounds, although treatment may be started immediately if the patient is acutely unwell or highly symptomatic at presentation – in which case, objective testing should be performed as soon as practicable, as spirometry and FeNO testing may be affected by the use of inhaled corticosteroids. […] NICE recommends the following strategy for confirming an asthma diagnosis: […] If asthma is not confirmed by FeNO, BDR, or PEF variability, but is still suspected clinically, either perform skin prick testing to house dust mite or measure total IgE level and blood eosinophil count. […] If there is still diagnostic doubt, refer to a paediatric specialist for a second opinion and consideration of a bronchial challenge test.

• #29 Overdiagnosis of asthma in children in primary care: a retrospective analysis | British Journal of General Practice

  https://bjgp.org/content/66/644/e152

  Asthma is one of the most common chronic diseases in childhood. According to guidelines, a diagnosis of asthma should be confirmed using lung function testing in children aged 6 years. Previous studies indicate that asthma in children is probably overdiagnosed. However, the extent has not previously been assessed. […] To assess the extent and characteristics of confirmed and unconfirmed diagnoses of asthma in children who were diagnosed by their GP as having asthma or who were treated as having asthma. […] In only 16.1% (n = 105) of the children diagnosed with asthma was the diagnosis confirmed with spirometry, whereas in 23.2% (n = 151) the signs and symptoms did give rise to suspected asthma but the children should have undergone further lung function tests. In more one-half (53.5%, n = 349) of the children the signs and symptoms made asthma unlikely and thus they were most likely overdiagnosed. The remaining 7.2% (n = 47) were probably correctly classified as not having asthma.

• #30 Overdiagnosis of asthma in children in primary care: a retrospective analysis | British Journal of General Practice

  https://bjgp.org/content/66/644/e152

  Overdiagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden, and impact on quality of life. However, only in a small percentage of children is a diagnosis of asthma confirmed by lung function tests. […] International guidelines state that a combination of a suggestive medical history, physical examination, lung function tests, and additional tests will provide the information needed to ensure a correct diagnosis of asthma. […] Assessment of lung function is regarded as essential for the diagnosis and therefore advised in all asthma guidelines to ensure a correct diagnosis, because signs and symptoms alone are insufficient. […] A study in the US found that 75% of family physicians perform spirometry on children. Surprisingly, only 36% of them indicate routine use to establish an asthma diagnosis as recommended by national guidelines.

• #31

  https://link.springer.com/article/10.1007/s11882-002-0083-1

  Asthma is a respiratory syndrome that frequently is underdiagnosed, particularly in young children. This primarily results from the lack of clinically useful criteria for making the diagnosis in the absence of objective tests, which are problematic in young children. […] Because new information suggests that delayed diagnosis may lead to permanently decreased lung function that could be prevented by early treatment, it is important that an accurate diagnosis be made as early as possible. […] Although simple criteria exist for determining if a patient has asthma, there is a tendency to delay making the diagnosis for a variety of reasons, including the observation that many children who begin wheezing at an early age stop wheezing by the time they are 6 years of age, and concerns over adverse effects from falsely labeling a patient with a potentially stigmatizing condition.

• #32 Pediatric Asthma Diagnosis | Does Your Child Has Asthma?

  https://www.nationaljewish.org/conditions/pediatric-asthma/overview/diagnosis

  We recommend this if any one of the following occurs: Severe asthma episode, Several visits to urgent care or emergency room or hospitalization during the last year, Conditions that complicate asthma such as chronic sinusitis, nasal polyps or vocal cord dysfunction, Frequent treatment with steroid tablets or syrup, Confusion with the diagnosis, Allergies are being considered, Asthma seems to be getting worse, Poor or no response to medications. […] In evaluating your childs progress, remember that asthma is a chronic condition that will change in course from time to time. If you feel that your child is not making progress with his or her current treatment, let your childs doctor know your concerns. If things are not going well, ask your childs doctor about seeing a specialist. You should not feel embarrassed about asking for another opinion.

• #33 Preschool asthma (1-5 years)

  https://www.rch.org.au/clinicalguide/guideline_index/Preschool_asthma_(1-5_years)/

  Indications for commencing preventer treatment are frequent daytime symptoms, frequent night-time symptoms, recurrent hospital presentations requiring asthma treatment, and frequent exacerbations. […] Combination ICS/LABA inhalers are not recommended in this age group outside of specialist use. […] Review if asthma is the correct diagnosis. […] Consider consultation with local paediatric team, respiratory or specialist asthma service when inadequate asthma control achieved at Step 4 or diagnosis of asthma uncertain.

• #34 Update on the diagnosis of severe asthma in children and adolescents

  https://www.explorationpub.com/Journals/eaa/Article/100965

  The rapid advancements of precision medicine in pediatric asthma have allowed us to identify phenotypes, endotypes, genetic markers, and biomarkers that have helped us better understand the mechanisms of severe asthma. […] This article aims to analyze the evidence in the diagnosis of severe asthma in children and adolescents in recent years. […] A review of the scientific evidence on severe pediatric asthma between October and November 2024 was conducted. […] The study of the human genome has allowed the discovery of new genes involved in pathogenesis, interaction with the environment, and response to treatment in pediatric severe asthma. […] With the advancement of precision medicine, the use of biomarkers is attaining increasing importance in the identification of endotypes (type 2 and non-type 2), prediction, and monitoring of response to new treatments (e.g., biological) in severe pediatric asthma.

• #35 asthma-diagnosis-infants – Asthma Initiative of Michigan

  https://getasthmahelp.org/asthma-diagnosis-infants/

  In order to diagnose asthma in a child, health care providers must: […] Take a good medical history of the child, including: […] Characteristics of the child’s home […] Triggers and/or aggravating factors […] Development of disease and current treatment […] Do a complete physical exam, looking for: […] Do objective measurements, if possible. Consider asthma if any of the above indicators are present, then confirm with spirometry. If the child is too young for spirometry to be done, diagnosis should be made based on the medical history, physical exam and/or response to asthma treatment. […] Children with asthma may need additional tests to aid and/or confirm the diagnosis. […] The Asthma Predictive Index (API), is a guide to determining which small children will likely have asthma in later years (i.e., persistent asthma). […] Referral to a specialist is recommended for consultation or co-management.

• #36

  https://www.healthychildren.org/English/health-issues/conditions/allergies-asthma/Pages/Asthma-Predictive-Index.aspx

  One in every 10 kids in the United States has asthma, a breathing condition that can affect nearly every part of their lives. […] Research shows that a family history of asthma is a risk that your child may develop it too. […] Early allergy symptoms are another possible red flag. […] Respiratory infections with wheezing is one sign that your child might be at higher risk for asthma later. Their pediatrician will look for other signs too. They may use tools such as the Asthma Predictive Index (API) and the Pediatric Asthma Risk Score (PARS). […] The API is based on a study of 1,000 children diagnosed with asthma before starting school (5 years old or earlier). […] The Pediatric Asthma Risk Score (PARS) tool was developed using data from the Cincinnati Childhood Allergy and Air Pollution Study.

• #37 Update on the diagnosis of severe asthma in children and adolescents

  https://www.explorationpub.com/Journals/eaa/Article/100965

  Eosinophils (EOs) can be measured in blood, sputum, or bronchoalveolar lavage (BAL) and in asthma have been used as biomarkers in diagnosis, prognosis, and response to treatment. […] In children and adolescents with severe uncontrolled asthma, the use of fractional exhaled nitric oxide (FeNO) with values less than or greater than 20 parts per billion (ppb) is recommended in conjunction with blood EOs levels to determine, based on age (6 to 11 years or 12 years), the most appropriate biological drug. […] The usefulness of lung function in severe asthma monitoring is fundamental. […] Recent advances in chest computed tomography (CT) have opened the door to a better understanding of obstructive disease in severe pediatric asthma. […] In recent years, the use of BC in severe pediatric asthma has had a resurgence, mainly to rule out alternative diagnoses, search for germs associated with the persistence of symptoms, or in situ measurement of inflammatory markers in patients undergoing treatment with high doses of steroids, or to identify candidates for the use of biologics.

• #38 Update on the diagnosis of severe asthma in children and adolescents

  https://www.explorationpub.com/Journals/eaa/Article/100965

  Genetic markers, biomarkers, lung function, radiological techniques, and BC are supportive tests and/or procedures for pediatric respiratory physicians to identify the endotype and/or phenotype of the child or adolescent with severe pediatric asthma. […] Despite all these limitations, diagnostic studies in severe pediatric asthma are useful in patients in whom it is necessary to know the phenotype/endotype, monitor disease activity, and select the treatment to reduce economic costs and/or adverse effects of unnecessary treatments.

• #39 Pediatric Asthma Diagnosis – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/services/asthma/diagnosis.html

  If youre wondering whether your child has asthma, youre not alone. The most common question our pediatric pulmonologists get asked is: My child wheezes and coughs a lot. Is it asthma? […] They have decades of experience diagnosing and treating asthma in children, so they can pinpoint whether a child has asthma or another lung disease and develop an effective treatment plan. […] The diagnostic process varies for each patient, but it usually includes: Understanding the childs medical history, including how the child handles infections and what triggers his or her symptoms […] Examining the childs respiratory system and overall health to look for other issues or illnesses that may be impacting his or her breathing […] Testing the childs breathing. Most children can do breathing tests by age 6, though some preschoolers are able to do this. We also conduct exercise and allergy testing when appropriate. […] Diagnosing asthma early on is critical and improves the odds of long-term, successful management.

• #40 How Early Can You Spot Asthma in Kids? Advice from an Expert

  https://www.hackensackmeridianhealth.org/en/healthu/2023/06/30/how-early-can-you-spot-asthma-in-kids

  An early asthma diagnosis could help many kids avoid urgent care visits, hospitalizations, multiple days missed from school and long-term complications from having poorly controlled symptoms. […] Signs of asthma can appear as early as infancy. […] If parents notice any of these signs, their child might have an underlying kind of chronic respiratory illness that needs to be further evaluated or diagnosed, Dr. Phull says. […] When a parent suspects asthma in their child, Dr. Phull says he spends the majority of the first visit going through their personal and family history, gathering information and determining if the child fits the clinical definition for asthma. If a child has a positive reaction to the medication albuterol, by definition, that is asthma, he says. […] For children who are a little older and can handle it, a doctor may also perform tests to verify the diagnosis: Lung function test: Called spirometry, this test measures how much air is exhaled and how quickly. This test can be performed at rest, after exercise and after taking asthma medication. […] These tests can provide an objective measure of expiratory volumes and expiratory flow rates, and from that, we can get a good idea about what function looks like and the degree of reversibility when given medication, Dr. Phull says.

• #41 Asthma in children – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/782

  Child-specific asthma guidelines should be used. Asthma in children is different from asthma in adults; adult or adolescent guidelines should not be extrapolated to younger age groups. […] A number of important differential diagnoses, and adherence and environmental issues should be considered when evaluating a child with suspected asthma, especially in very young children or when high doses of inhaled corticosteroids are required. […] Key diagnostic factors include presence of risk factors, wheezing episode triggers, increased work of breathing, features of atopic disease, and history of response to treatment within appropriate time frame. […] 1st investigations to order include spirometry, peak expiratory flow (PEF), and response to bronchodilator. […] Emerging tests include fractional expired nitric oxide (FeNO).

• #42 Childhood Asthma: Symptoms, Diagnosis, and Treatment – Greater Knoxville ENT

  https://greaterknoxent.com/childhood-asthma-symptoms-diagnosis-treatment/

  Childhood Asthma: Symptoms, Diagnosis, and Treatment […] Asthma is a chronic disease that affects nearly 9 million children in the United States. […] How is asthma diagnosed? There are childhood conditions that have similar symptoms to asthma. To diagnose asthma in children, the doctor has to do a physical exam, take your child’s medical history, and run some tests to rule out other conditions. Some of the tests your child may undergo include lung function and exhaled nitric oxide tests. These tests, however, aren’t accurate for children below 5 years old. For kids younger than that, the doctor will rely on the information you give, such as the child’s symptoms and medical history. […] If you suspect your child has asthma, see a doctor immediately. When left unmanaged, asthma can be a life-threatening condition.

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